Brand Name | CONSERVE A-CLASS BFH HEAD MEDIUM NECK 46MM |
Type of Device | HIP COMPONENT |
Manufacturer (Section D) |
MICROPORT ORTHOPEDICS INC. |
5677 airline rd. |
arlington TN 38002 |
|
Manufacturer (Section G) |
MICROPORT ORTHOPEDICS INC. |
5677 airline rd. |
|
arlington TN 38002 |
|
Manufacturer Contact |
|
5677 airline road |
arlington, TN 38002
|
9018674771
|
|
MDR Report Key | 11059348 |
MDR Text Key | 223364730 |
Report Number | 3010536692-2020-00783 |
Device Sequence Number | 1 |
Product Code |
KWA
|
UDI-Device Identifier | M68438AM46001 |
UDI-Public | M68438AM46001 |
Combination Product (y/n) | N |
Reporter Country Code | US |
PMA/PMN Number | K021349 |
Number of Events Reported | 1 |
Summary Report (Y/N) | N |
Report Source |
Manufacturer
|
Source Type |
other |
Reporter Occupation |
Physician
|
Type of Report
| Initial |
Report Date |
12/22/2020 |
1 Device was Involved in the Event |
|
1 Patient was Involved in the Event |
|
Is this an Adverse Event Report? |
Yes
|
Is this a Product Problem Report? |
No
|
Device Operator |
Health Professional
|
Device Model Number | 38AM4600 |
Device Catalogue Number | 38AM4600 |
Device Lot Number | 026309785 |
Was Device Available for Evaluation? |
No
|
Is the Reporter a Health Professional? |
Yes
|
Was the Report Sent to FDA? |
No
|
Distributor Facility Aware Date | 11/30/2020 |
Initial Date Manufacturer Received |
Not provided |
Initial Date FDA Received | 12/22/2020 |
Was Device Evaluated by Manufacturer? |
Device Not Returned to Manufacturer
|
Is the Device Single Use? |
Yes
|
Type of Device Usage |
N
|
Patient Sequence Number | 1 |
Patient Outcome(s) |
Required Intervention;
|